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    Clinical Trial Results:
    Long-term Safety Follow-up of Subjects With Giant Cell Tumor of Bone Treated With Denosumab in Study 20062004

    Summary
    EudraCT number
    2017-001758-32
    Trial protocol
    SE   GB   ES   PL   FR   IT  
    Global end of trial date
    27 Jul 2023

    Results information
    Results version number
    v1
    This version publication date
    17 Dec 2023
    First version publication date
    17 Dec 2023
    Other versions
    v2

    Trial information

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    Trial identification
    Sponsor protocol code
    20140114
    Additional study identifiers
    ISRCTN number
    -
    US NCT number
    NCT03301857
    WHO universal trial number (UTN)
    -
    Sponsors
    Sponsor organisation name
    Amgen Inc.
    Sponsor organisation address
    One Amgen Center Drive, Thousand Oaks, CA, United States,
    Public contact
    IHQ Medical Info-Clinical Trials, Amgen (EUROPE) GmbH, MedInfoInternational@amgen.com
    Scientific contact
    IHQ Medical Info-Clinical Trials, Amgen (EUROPE) GmbH, MedInfoInternational@amgen.com
    Paediatric regulatory details
    Is trial part of an agreed paediatric investigation plan (PIP)
    No
    Does article 45 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Does article 46 of REGULATION (EC) No 1901/2006 apply to this trial?
    No
    Results analysis stage
    Analysis stage
    Final
    Date of interim/final analysis
    27 Jul 2023
    Is this the analysis of the primary completion data?
    No
    Global end of trial reached?
    Yes
    Global end of trial date
    27 Jul 2023
    Was the trial ended prematurely?
    No
    General information about the trial
    Main objective of the trial
    Study 20140114 continued to follow subjects with Giant Cell Tumor of Bone (GCTB) who were treated in Study 20062004 and remained on the study at the completion of Study 20062004 for an additional 5 years on long-term safety follow up.
    Protection of trial subjects
    This study was conducted in accordance with International Council for Harmonisation (ICH) Good Clinical Practice (GCP), Declaration of Helsinki, and applicable national or regional regulations/guidelines. Essential documents will be retained in accordance with ICH GCP. The study sponsor declares that the information provided in this report is an accurate representation of the data captured and analyses performed for this study.
    Background therapy
    -
    Evidence for comparator
    -
    Actual start date of recruitment
    13 Nov 2017
    Long term follow-up planned
    Yes
    Long term follow-up rationale
    Safety
    Long term follow-up duration
    5 Years
    Independent data monitoring committee (IDMC) involvement?
    No
    Population of trial subjects
    Number of subjects enrolled per country
    Country: Number of subjects enrolled
    United States: 31
    Country: Number of subjects enrolled
    Italy: 17
    Country: Number of subjects enrolled
    France: 15
    Country: Number of subjects enrolled
    Poland: 8
    Country: Number of subjects enrolled
    Australia: 4
    Country: Number of subjects enrolled
    United Kingdom: 4
    Country: Number of subjects enrolled
    Spain: 3
    Country: Number of subjects enrolled
    Sweden: 3
    Worldwide total number of subjects
    85
    EEA total number of subjects
    46
    Number of subjects enrolled per age group
    In utero
    0
    Preterm newborn - gestational age < 37 wk
    0
    Newborns (0-27 days)
    0
    Infants and toddlers (28 days-23 months)
    0
    Children (2-11 years)
    0
    Adolescents (12-17 years)
    2
    Adults (18-64 years)
    78
    From 65 to 84 years
    4
    85 years and over
    1

    Subject disposition

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    Recruitment
    Recruitment details
    Subjects with GCTB were recruited across 8 countries (Australia, Italy, France, Poland, Spain, Sweden, the United Kingdom of Great Britain and Northern Ireland, and the United States) between November 2017 and July 2023.

    Pre-assignment
    Screening details
    Study 20140114 was a prospective, multicenter, open label, phase 4 study that provided long term safety follow up for participants who completed Study 20062004 and provided consent to enroll in Study 20140114.

    Period 1
    Period 1 title
    Overall (overall period)
    Is this the baseline period?
    Yes
    Allocation method
    Non-randomised - controlled
    Blinding used
    Not blinded

    Arms
    Are arms mutually exclusive
    Yes

    Arm title
    Exposed to Investigational Product (IP)
    Arm description
    Participants who received denosumab at the conclusion of Study 20062004 continued receiving denosumab at the current dose (120 mg every 4 weeks [Q4W] subcutaneous injection [SC]) and schedule at the investigator’s discretion.
    Arm type
    Experimental

    Investigational medicinal product name
    Denosumab
    Investigational medicinal product code
    Other name
    XGEVA
    Pharmaceutical forms
    Solution for injection in pre-filled syringe
    Routes of administration
    Subcutaneous use
    Dosage and administration details
    120 mg Q4W SC

    Arm title
    Not Exposed to IP
    Arm description
    Participants who completed denosumab treatment in Study 20062004 and were in the safety follow up at the conclusion of Study 20062004 continued in long term safety follow up in this study (Study 20140114), and did not received denosumab.
    Arm type
    No intervention

    Investigational medicinal product name
    No investigational medicinal product assigned in this arm
    Number of subjects in period 1
    Exposed to Investigational Product (IP) Not Exposed to IP
    Started
    51
    34
    Completed
    29
    26
    Not completed
    22
    8
         Consent withdrawn by subject
    12
    4
         Decision by Sponsor
    6
    -
         Death
    -
    2
         Lost to follow-up
    4
    2

    Baseline characteristics

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    Baseline characteristics reporting groups
    Reporting group title
    Exposed to Investigational Product (IP)
    Reporting group description
    Participants who received denosumab at the conclusion of Study 20062004 continued receiving denosumab at the current dose (120 mg every 4 weeks [Q4W] subcutaneous injection [SC]) and schedule at the investigator’s discretion.

    Reporting group title
    Not Exposed to IP
    Reporting group description
    Participants who completed denosumab treatment in Study 20062004 and were in the safety follow up at the conclusion of Study 20062004 continued in long term safety follow up in this study (Study 20140114), and did not received denosumab.

    Reporting group values
    Exposed to Investigational Product (IP) Not Exposed to IP Total
    Number of subjects
    51 34 85
    Age Categorical
    Units: Subjects
        In utero
    0 0 0
        Preterm newborn infants (gestational age < 37 wks)
    0 0 0
        Newborns (0-27 days)
    0 0 0
        Infants and toddlers (28 days-23 months)
    0 0 0
        Children (2-11 years)
    0 0 0
        Adolescents (12-17 years)
    1 1 2
        Adults (18-64 years)
    48 30 78
        From 65-84 years
    2 2 4
        85 years and over
    0 1 1
    Age Continuous
    Units: years
        arithmetic mean (standard deviation)
    42.4 ( 12.8 ) 46.7 ( 15.1 ) -
    Gender Categorical
    Units: Subjects
        Female
    32 23 55
        Male
    19 11 30
    Race
    Units: Subjects
        White
    35 31 66
        Other
    10 0 10
        Black (or African American)
    4 3 7
        Asian
    2 0 2
    Ethnicity
    Units: Subjects
        Hispanic/Latino
    13 10 23
        Not Hispanic/Latino
    38 24 62

    End points

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    End points reporting groups
    Reporting group title
    Exposed to Investigational Product (IP)
    Reporting group description
    Participants who received denosumab at the conclusion of Study 20062004 continued receiving denosumab at the current dose (120 mg every 4 weeks [Q4W] subcutaneous injection [SC]) and schedule at the investigator’s discretion.

    Reporting group title
    Not Exposed to IP
    Reporting group description
    Participants who completed denosumab treatment in Study 20062004 and were in the safety follow up at the conclusion of Study 20062004 continued in long term safety follow up in this study (Study 20140114), and did not received denosumab.

    Primary: Number of Participants Experiencing Adverse Events of Interest (EOI) in Participants with GCTB Treated with Denosumab in Study 20062004

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    End point title
    Number of Participants Experiencing Adverse Events of Interest (EOI) in Participants with GCTB Treated with Denosumab in Study 20062004 [1]
    End point description
    EOI assessed in the study were to be assessed for signs and symptoms of the adverse EOI of osteonecrosis of the jaw (ONJ), malignancy (including malignancy in GCTB), atypical femoral fracture (AFF), hypocalcemia, hypercalcemia after treatment discontinuation, pregnancy and lactation (if occurring on treatment or within 5 months of last dose of denosumab).
    End point type
    Primary
    End point timeframe
    Up to Approximately 5 Years
    Notes
    [1] - No statistical analyses have been specified for this primary end point. It is expected there is at least one statistical analysis for each primary end point.
    Justification: This endpoint was specified only for the IMP-exposed group.
    End point values
    Exposed to Investigational Product (IP) Not Exposed to IP
    Number of subjects analysed
    51 [2]
    34
    Units: Count of Participants
        Adj+ Osteonecrosis of jaw - Adverse Events (AE)
    3
    0
        Malignancy, including malignancy in GCTB - AE
    6
    1
        Adj+ Atypical femoral fracture - AE
    2
    0
        Hypocalcemia - AE
    3
    0
        Hypocalcemia after treatment end - AE
    0
    0
        Pregnancy and lactation
    0
    0
    Notes
    [2] - One pregnancy in female partners of male subjects treated with denosumab was reported
    No statistical analyses for this end point

    Secondary: Number of Participants Experiencing Treatment-emergent Adverse Events (TEAE) for Participants who Received Denosumab.

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    End point title
    Number of Participants Experiencing Treatment-emergent Adverse Events (TEAE) for Participants who Received Denosumab. [3]
    End point description
    An adverse event is any untoward medical occurrence in a clinical study subject irrespective of a causal relationship with the study treatment. An adverse event is considered as treatment emergent if the adverse event occurs during the time period from the first dose of investigational product (IP) in this study through last dose of IP plus 30 days. TEAEs related to IP include only TEAEs for which the investigator indicated there was a reasonable possibility they may have been caused by IP.
    End point type
    Secondary
    End point timeframe
    Up to Approximately 5 Years
    Notes
    [3] - The end point is not reporting statistics for all the arms in the baseline period. It is expected all the baseline period arms will be reported on when providing values for an end point on the baseline period.
    Justification: This endpoint was specified only for the IMP-exposed group.
    End point values
    Exposed to Investigational Product (IP)
    Number of subjects analysed
    51
    Units: Count of Participants
        All TEAEs
    47
        Serious TEAEs
    8
        Fatal TEAEs
    0
        TEAEs leading to IP discontinuation
    9
        CTCAE Grade 3, 4, or 5
    16
        All TEAEs related to IP
    14
    No statistical analyses for this end point

    Secondary: Number of Participants Experiencing Serious Adverse Events

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    End point title
    Number of Participants Experiencing Serious Adverse Events
    End point description
    A Serious Adverse Event is defined as any untoward medical occurrence that meets at least 1 of the following serious criteria: - Results in death (fatal) - Immediately life-threatening - Requires in-patient hospitalization or prolongation of existing hospitalization - Results in persistent or significant disability/incapacity - Is a congenital anomaly/birth defect - Other medically important serious event
    End point type
    Secondary
    End point timeframe
    From Date of Signing ICF up to Approximately 5 Years
    End point values
    Exposed to Investigational Product (IP) Not Exposed to IP
    Number of subjects analysed
    51
    34
    Units: Count of Participants
        Number of Participants Reporting Serious AE
    11
    6
    No statistical analyses for this end point

    Secondary: Number of Participants with Disease Progression or Recurrence of GCTB

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    End point title
    Number of Participants with Disease Progression or Recurrence of GCTB
    End point description
    Disease progression or recurrence is defined as the best post-baseline response of progressive disease (PD) without any post-baseline complete response (CR) /partial response (PR) /stable disease (SD) or a post-baseline response of PD following a postbaseline CR/PR/SD. PD is defined as the response of progressive disease, locally recurrent disease or distant recurrence as captured in the Disease Status page of the Case Report Form.
    End point type
    Secondary
    End point timeframe
    Up to Approximately 5 Years
    End point values
    Exposed to Investigational Product (IP) Not Exposed to IP
    Number of subjects analysed
    50 [4]
    33 [5]
    Units: Count of Participants
        Disease Progression or Recurrence
    5
    3
    Notes
    [4] - Number of subjects analyzed: subjects who had at least one post-baseline disease status evaluation.
    [5] - Number of subjects analyzed: subjects who had at least one post-baseline disease status evaluation.
    No statistical analyses for this end point

    Secondary: Summary of GCTB Interventions

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    End point title
    Summary of GCTB Interventions
    End point description
    Data from the full analysis set (FAS) which included all enrolled subjects (from Study 20062004) who provided informed consent and had a non-missing enrollment date in this study.
    End point type
    Secondary
    End point timeframe
    Up to Approximately 5 Years
    End point values
    Exposed to Investigational Product (IP) Not Exposed to IP
    Number of subjects analysed
    51
    34
    Units: Count of Participants
        Surgery for GCTB - Yes
    0
    0
        Surgery for GCTB - No
    51
    34
        Chemotherapy or Other Therapeutic Agents - Yes
    0
    1
        Chemotherapy or Other Therapeutic Agents - No
    51
    33
        Embolization - Yes
    0
    0
        Embolization - No
    51
    34
        Interferon - Yes
    0
    0
        Interferon - No
    51
    34
        Radiotherapy - Yes
    0
    0
        Radiotherapy - No
    51
    34
    No statistical analyses for this end point

    Adverse events

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    Adverse events information
    Timeframe for reporting adverse events
    AE from 1st dose to last dose+30 days in the study. Fatality from 1st dose to end-of-study (EOS) (approximately 5 years); two deaths from not dosed subjects are excluded. Median on IP: 53.4 Months.
    Adverse event reporting additional description
    20140114 Primary
    Assessment type
    Systematic
    Dictionary used for adverse event reporting
    Dictionary name
    MedDRA
    Dictionary version
    26.0
    Reporting groups
    Reporting group title
    Exposed to IP
    Reporting group description
    Participants who received denosumab at the conclusion of Study 20062004 continued receiving denosumab at the current dose (120 mg Q4W SC) and schedule at the investigator’s discretion.

    Serious adverse events
    Exposed to IP
    Total subjects affected by serious adverse events
         subjects affected / exposed
    8 / 51 (15.69%)
         number of deaths (all causes)
    0
         number of deaths resulting from adverse events
    Neoplasms benign, malignant and unspecified (incl cysts and polyps)
    Osteosarcoma
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Injury, poisoning and procedural complications
    Patella fracture
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Femur fracture
         subjects affected / exposed
    2 / 51 (3.92%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 2
         deaths causally related to treatment / all
    0 / 0
    Gastrointestinal disorders
    Gastrointestinal obstruction
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Anal fistula
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Musculoskeletal and connective tissue disorders
    Osteonecrosis of jaw
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    2 / 2
         deaths causally related to treatment / all
    0 / 0
    Myositis
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Infections and infestations
    Sepsis
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Medical device site infection
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Viral pericarditis
         subjects affected / exposed
    1 / 51 (1.96%)
         occurrences causally related to treatment / all
    0 / 1
         deaths causally related to treatment / all
    0 / 0
    Frequency threshold for reporting non-serious adverse events: 5%
    Non-serious adverse events
    Exposed to IP
    Total subjects affected by non serious adverse events
         subjects affected / exposed
    39 / 51 (76.47%)
    Injury, poisoning and procedural complications
    Foot fracture
         subjects affected / exposed
    4 / 51 (7.84%)
         occurrences all number
    5
    Nervous system disorders
    Headache
         subjects affected / exposed
    3 / 51 (5.88%)
         occurrences all number
    3
    Blood and lymphatic system disorders
    Anaemia
         subjects affected / exposed
    4 / 51 (7.84%)
         occurrences all number
    4
    General disorders and administration site conditions
    Pyrexia
         subjects affected / exposed
    3 / 51 (5.88%)
         occurrences all number
    3
    Gastrointestinal disorders
    Toothache
         subjects affected / exposed
    8 / 51 (15.69%)
         occurrences all number
    8
    Respiratory, thoracic and mediastinal disorders
    Cough
         subjects affected / exposed
    5 / 51 (9.80%)
         occurrences all number
    5
    Dyspnoea
         subjects affected / exposed
    3 / 51 (5.88%)
         occurrences all number
    3
    Musculoskeletal and connective tissue disorders
    Osteonecrosis of jaw
         subjects affected / exposed
    6 / 51 (11.76%)
         occurrences all number
    7
    Myalgia
         subjects affected / exposed
    4 / 51 (7.84%)
         occurrences all number
    4
    Back pain
         subjects affected / exposed
    7 / 51 (13.73%)
         occurrences all number
    9
    Arthralgia
         subjects affected / exposed
    8 / 51 (15.69%)
         occurrences all number
    13
    Pain in extremity
         subjects affected / exposed
    8 / 51 (15.69%)
         occurrences all number
    12
    Infections and infestations
    COVID-19
         subjects affected / exposed
    7 / 51 (13.73%)
         occurrences all number
    7
    Gingivitis
         subjects affected / exposed
    3 / 51 (5.88%)
         occurrences all number
    3
    Sinusitis
         subjects affected / exposed
    3 / 51 (5.88%)
         occurrences all number
    7
    Metabolism and nutrition disorders
    Hypocalcaemia
         subjects affected / exposed
    3 / 51 (5.88%)
         occurrences all number
    8

    More information

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    Substantial protocol amendments (globally)

    Were there any global substantial amendments to the protocol? Yes
    Date
    Amendment
    15 Nov 2017
    • Clarified guidance to investigators about monitoring subjects for hypercalcemia upon discontinuation or interruption of investigational product. • Added month 60 to the Schedule of Assessments for clarity.
    23 Jan 2018
    The objective of Study 20140114 was to continue to follow subjects with GCTB who were treated in Study 20062004. A minor language of inclusion criterion 101 was updated to clarify that: • To be considered potentially eligible for this study, a subject must had participated in the parent 20062004 study and had completed participation in that study, and • A subject could not be concurrently enrolled to Study 20062004 and Study 20140114; which was not clear according to the original protocol inclusion criterion 101.
    23 Aug 2018
    Schedule of Activities • Changed the interval between last dose of denosumab and the EOT in person clinic visit. Study Treatments • Added detail to denosumab dosing instructions. Serious Adverse Events • Clarified procedure for reporting serious adverse events and/or events of interest for subjects who experienced a treatment gap of more than 30 days between the EOS visit of Study 20062004 and signing the ICF for Study 20140114. Study Rationale • Clarified that Study 20062004 ended in May 2018, as the study was extended by a year. • Clarified that subjects with surgically salvageable disease, treatment continued until surgery for complete resection and for approximately 6 months after surgery, as aligned to the 20062004 study. Overall Design • Clarified that the EOS visit for all subjects was at 5 years. Cohort A subjects on investigational product had an EOS visit conducted 30 days after the last dose of investigational product (EOT visit) if received investigational product at the 5-year time point. Lost to Follow up • Clarified that investigators will not search publicly available records to ascertain survival status when a subject is lost to follow-up. Discontinuation of Study Treatment • Clarified that upon discontinuation, subject’s risk for vertebral fragility fractures were evaluated. This language was being added to align language with the core data sheet.

    Interruptions (globally)

    Were there any global interruptions to the trial? No

    Limitations and caveats

    Limitations of the trial such as small numbers of subjects analysed or technical problems leading to unreliable data.
    None reported
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    The status and protocol content of GB trials is no longer updated since 1 January 2021. For the UK, as of 31 January 2021, EU Law applies only to the territory of Northern Ireland (NI) to the extent foreseen in the Protocol on Ireland/NI. Legal notice
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